First attack of gout…help!!

[Al O’Purinol]

I am writing on behalf of my 47 year old husband who is in so much pain.My husband appears to have gout in his ankle, it came on without any previous problems, he is not over weight nor does he have high blood pressure he works as a self employed joiner,he is very active and works at a fast pace.On sunday 21st september he complained of a slight ache in his ankle,on monday it was much worse but carried on working,tuesday morning he was really struggling but insisted on going to work.On tuesday evening he crawled into the house, we are now four days on, he is unable to weight bare and is in agony,he is taking regular cocodamol and diclofenac 50mg 3x daily.The pain is unbearable at night, he also seems to be getting a fever at night.Is this a normal pattern for a first attack? How much longer will it last, will it ease gradually or disappear overnight?The doctor has taken a blood test but says gout hasnot shown up….I don’t see what else it can be? Any advice would be gratefully recieved. Thanks

[Keith Taylor]

Hi @23september welcome to the gout forum. I’m guessing you are in the UK, so I will try to phrase my recommendations accordingly.

A clear diagnosis is fundamental to correct management of gout. We don’t have that diagnosis, so that makes life difficult.

Whenever gout diagnosis is in doubt, I recommend immediate consultation with a rheumatologist. Providing they have the right microscopy equipment on-site, you can get a clear diagnosis within minutes in almost all cases. If they don’t have a polarizing microscope, use a different rheumatologist.

Without that diagnosis, we are in guessing-game territory, but a logical approach might help.

Even if it is not gout, it clearly falls into severe pain category. By the time you read this, it is going to be another Sunday, so medical assistance is limited. I am concerned that your husband’s pain relief is not sufficient for the severity of pain he is suffering. Unfortunately, I’m not qualified to advise you about the maximum dose of your husbands meds. Does your doctor have an out-of-hours number? A local Sunday pharmacy might help, but you’d probably have more luck with the local hospital.

I have to repeat that this forum is not the place for personal medical advice. As a gout sufferer, I am advising you that standard doses of most over-the-counter pain relief is not sufficient. Female gout sufferers have told me that the pain of gout is worse than childbirth. How long would a midwife survive giving a couple of Voltaren for labour pains?

Information on GoutPal is provided by a gout patient to help you understand gout and related issues. Gout information is provided by a layman, with no medical training or qualifications. It should not be used for diagnosing or treating any health problem or disease. The information is given to help you understand your doctor’s advice and know what questions to ask. It is not a substitute for professional care. If you have an actual or suspected health problem, you should consult your doctor.

I think we have to manage the pain first, then manage the gout, once we confirm it is gout.

“The doctor has taken a blood test but says gout hasnot shown up?.I don?t see what else it can be?”
It could be pseudogout or septic arthritis, or a doctor who doesn’t understand uric acid test results.

A rheumatologist can distinguish between gout and other diseases that display similar symptoms. For more insight into your test results, I need to know the exact uric acid number. Many doctors get confused because they have a compulsion to look at reference ranges, which are meaningless for diagnosis. When that is combined with the fact that blood uric acid is often lower during an attack, you can see why gout diagnosis is frequently missed.

Because this is a gout forum, I’m heavily swayed towards the belief that this is gout, though please heed my advice about other possibilities.

If it is gout, the other things your husband should do now is to keep hydrated, keep the ankle above heart level as much as possible, and keep it warm.

Keep warm
Bed socks and microwave heat bags are good. Maybe it’s time for untreated gout sufferers to bring back the Great British Hot Water Bottle!
Keep hydrated
Around 3 litres fluid daily, but the real test is not the intake, but the fact that urine should be a pale straw colour. All fluids count.
Rest and mobility
Whenever the pain relief allows, keep the joint moving with gentle walking. Your husband might need a leap of faith here. I want him to wait 20 mins after taking pain relief, then push himself to walk at least half a mile. In my experience, the limping is almost gone after about 300 yards.

Gout attacks do tend to subside quickly, but every attack is different. We all hope it will end soon, but the most important thing is to learn the best pain control strategy that works for your husband.

For diet, please ignore everything about purines for now. They are not linked to gout attacks except as a long term measure for partial uric acid control. They might be important later, but for now, any diet changes need to focus on inflammation control. This means limiting saturated fatty acids, increasing polyunsaturated fats, and increasing vegetables and fruit, especially dark colourful veg. I’m working on better dietary advice for inflammation control, so if anyone can chip in with better advice here, your contributions are most welcome. If your husband is hoping for a big Sunday dinner for comfort eating, maybe today would be a good day to miss anything with animal fats (meat, gravy, cheese, pastry etc). You’re welcome to join me for veg curry.

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